- Welcome to WestWind Homes -

Applicant's Name: E-mail:
SS#: Phone Numbers Day: Evening:
Address: Apt/Lot: City: State: Zip:

List Previous Addresses Within the United States if Address Changed During the Past 5 Years

Previous Address: Apt/Lot: City: State: Zip:

Job Criteria

Type of work desired: Salary Requirements:
How were you referred to us? Date available to work:
Have you been employed by our organization before? Are you 18 years of age or older?
Are you eligible to work in the United States?

Skills

Professional Licenses and/or Certificates: Type: Number:
Organization or State issued: Date Issued:
Foreign Languages: Other Skills:
Typing WPM: Dictation WPM: 10 Key by touch?
PC/CRT? No. Years:
Proefficient in what PC Programs:
Type of Computer List any other business machines:

EMPLOYMENT RECORD
Starting with Present or Most Recent, list all previous employers. List only employers within the United States. Include self employment, summer and part-time jobs, as well as military service.

Company Name : Address: City: State: Zip:
Supervisor Name: Supervisor's Position:
Your Position Work Phone: Duties:
Date from: to Starting Salary: $ Ending Salary: $
Reason for Leaving:

If you are employed, may we contact your present employer?
If presently employed, why do you desire to change your position?

Unemployment Record
Account for all periods of unemployment fo 2 weeks duration or more since you left school to present time.

Date from: to State what you were doing:
Date from: to State what you were doing:

Miscellaneous
Names of relatives, friends or co-habitants working for this organization:

Other names used in previous employment:
Have you ever been convicted of a criminal offense involving dishonesty or breach of trust (including but not limited to robbery, embezzlement, forgery, perjury, tax evasion, etc.)?

TERMS * Required
I hereby affirm that my answers to the questions herein are true and correct. I recognize that a routine investigation may be made for verification of all statements contained in this application; and in addition, an investigative inquiry may be pursued to provide information on my character, credit, general reputation and personal characterisitcs; and should such an inquiry be made, more information about the nature and scope of said inquiry will be furnished me upon written request. I further understand that misrepresentation or omission of facts called for on this application is cause for rejection of this application or for subsequent dismissal from employment. If employed, I agree to comply with and be bonded by the rules, regulations and policies of this employer.

I fully understand that this is an application for empoyment and that no employment contract is beint offered; and I understand that if employed, such employment is for an indefinite period and is subject to change in wages, conditions, benefits, and operating policies. I understand that if hired, my employment will be "AT WILL," and can be terminated at any time, without notice and without cause. I understand that my "AT WILL" status will remain in effect throughout my employment with the organization and any of its parent, subsidiary, or affiliated entites. I expressly understand that this "AT WILL" relationship cannot be modified or altered by any oral or implied agreement.

If employed, I also agree to submit to a physical examination at any time, at the request of this organization, and agree that the examining physician may disclose the findings to an authorized agent of this organization.



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